Background:Concerns about falling and impaired functional mobility are established fall-risk indicators, but prospective fall risk is less clear when subjective concerns and objective mobility are discordant. We compared incident falls across joint profiles of concerns about falling and Timed Up and Go (TUG) performance, with particular attention to older adults with fast TUG performance and concerns versus those with slow TUG performance and no concerns. Methods:This one-year prospective cohort study included 2,445 community-dwelling adults aged 60-79 years in Zhejiang Province, China. TUG performance was classified as fast (<12 s) or slow (≥12 s), and concerns about falling were assessed using a single yes/no item. Crossing the two measures produced four psychophysical groups. Self-reported falls were recorded on daily calendars and ascertained monthly. Cox regression estimated adjusted hazard ratios (HRs) for time to first fall. Sensitivity analyses used the Falls Efficacy Scale-International (FES-I), excluded participants with a baseline fall history, and applied the guideline-aligned TUG >15 s threshold. Results:During follow-up, 232 participants (9.5%) reported at least one fall; 2,420 (98.98%) completed follow-up. Single-item concerns (adjusted HR 1.60, 95% CI 1.23-2.09) and slow TUG performance (HR 1.46, 95% CI 1.10-1.92) were independently associated with incident falls. Using the slow-TUG/no-concern group as the direct reference, the fast-TUG/concern group did not differ significantly (HR 1.08, 95% CI 0.72-1.63), whereas the slow-TUG/concern group had a higher hazard (HR 1.96, 95% CI 1.29-2.97). The discordant groups also did not differ after excluding baseline fallers (HR 0.97, 95% CI 0.62-1.52) or after additionally applying the TUG >15 s threshold (HR 0.87, 95% CI 0.46-1.63). Conclusion:Concerns about falling and TUG performance provided complementary information about subsequent falls. The two discordant profiles were not significantly separated. These findings support considering concerns alongside mobility performance rather than relying on either measure alone.
Background:Frailty is a clinically significant geriatric syndrome characterized by reduced physiological reserve and increased vulnerability to stressors, resulting in a higher risk of adverse health outcomes such as functional decline, hospitalization, institutionalization, and mortality. Its early identification is essential for risk stratification, care planning, and individualized intervention. As no universal biomarker of frailty exists, its assessment relies on standardized clinical assessment instruments. However, the available tools are not interchangeable, and their optimal use depends on the clinical setting, the purpose of assessment, and organizational capacity. Methods:A narrative review was conducted using PubMed/MEDLINE, Scopus, and Web of Science, supplemented by manual screening of reference lists of key articles, methodological papers, and international recommendations. The literature search was current to March 2026. Ten frailty assessment instruments were included based on predefined eligibility criteria, including external validation in large cohorts, demonstrated prognostic performance in more than one independent study, or endorsement in international geriatric guidelines: the FRAIL scale (Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight), the Study of Osteoporotic Fractures (SOF) index, the Clinical Frailty Scale (CFS), the Program of Research to Integrate Services for the Maintenance of Autonomy 7-item questionnaire (PRISMA-7), the Vulnerable Elders Survey-13 (VES-13), the Fried frailty phenotype, the Tilburg Frailty Indicator (TFI), the Groningen Frailty Indicator (GFI), the Edmonton Frail Scale (EFS), and the Frailty Index derived from Comprehensive Geriatric Assessment (FI-CGA). Findings:The reviewed instruments differ in their conceptual background, including phenotypic, deficit-based, and multidomain approaches, as well as in assessed domains, time requirements, and staffing demands. They are therefore not directly interchangeable. Based on this synthesis, a stepwise, context-oriented pathway for instrument selection is proposed. Brief screening tools such as PRISMA-7 or the FRAIL scale may be suitable at first contact in outpatient and community care; the CFS may support rapid clinical stratification in acute hospital and emergency settings; multidomain instruments such as the EFS may be appropriate when a broader clinical overview is required but full comprehensive geriatric assessment (CGA) is not feasible; and CGA supplemented by a deficit accumulation index such as the FI-CGA may be most appropriate in specialized geriatric care and individualized management planning. Conclusion:The stepwise pathway proposed in this review represents a conceptual framework synthesized from the available literature rather than a prospectively validated clinical protocol. Its purpose is to support clinicians in selecting an appropriate frailty assessment instrument for a defined clinical situation. Prospective evaluation across different healthcare settings is needed before the pathway can be regarded as an evidence-based protocol for routine practice.
Background:Systemic immunochemotherapy is the standard of care in patients with advanced non-small cell lung cancer (NSCLC) without druggable driving mutations, yet many older patients cannot tolerate systemic chemotherapy. Bronchial arterial chemoembolization (BACE) represents an alternative to systemic chemotherapy for this population. Methods:This retrospective single-center study included consecutive patients with stage IIIC-IV NSCLC over 65 years old who underwent BACE or systemic chemotherapy, plus a PD-1 inhibitor, in our hospital from August 2019 to October 2024. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were compared between the two groups. Results:The final analysis included 81 patients: 39 and 42 in the chemotherapy and BACE groups, respectively. In comparison to the chemotherapy group, the BACE group had older age (median age: 78 vs 71 years) and poorer Eastern Cooperative Oncology Group Performance Status (ECOG PS≥2: 47.6% vs 2.6%). The ORR was 73.8% in the BACE group vs 64.1% in the chemotherapy group. The median PFS was 5.4 months in the BACE group vs 5.2 months in the chemotherapy group (P=0.841). The median OS was 10.3 months in the BACE group vs 8.7 months in the chemotherapy group (P=0.449). Neither PFS nor OS differed significantly between the 2 groups in either Cox proportional hazards regression or inverse probability of treatment weighting analyses. The BACE group had lower rate of myelosuppression (28.6% vs 74.4%) but higher rate of dyspnea (16.7% vs 0%). No treatment-related serious AEs, eg, spinal artery injury due to ectopic embolism or venous thrombosis of the lower limb, were reported in the BACE group. Conclusion:In older patients with stage IIIC-IV NSCLC, BACE combined with PD-1 inhibitor showed no statistically inferior response or survival versus chemoimmunotherapy. These exploratory results require validation in large prospective cohorts.
Purpose:The association between body mass index (BMI) and anemia remains inconsistent across populations. This study aimed to examine the association between BMI categories and prevalent anemia in postmenopausal women with osteoporotic vertebral compression fractures (OVCFs). Patients and Methods:In this single-center, hospital-based cross-sectional study, 351 postmenopausal women with OVCFs admitted to a tertiary hospital in East China between July 2018 and June 2024 were included. BMI was categorized according to Chinese criteria. Anemia was defined as hemoglobin <120 g/L. Associations between BMI, hemoglobin levels, and prevalent anemia were assessed using correlation analyses, multiple linear regression, and sequential multivariable logistic regression models. Results:Overall, 156 patients (44.4%) had anemia. The prevalence of anemia was highest in the underweight group (77.1%), followed by the normal-weight (42.9%), overweight (33.3%), and obese (31.3%) groups. Hemoglobin levels increased across BMI categories, and BMI was positively correlated with hemoglobin levels (rs = 0.317, P < 0.001). In multivariable analyses, underweight status was associated with lower hemoglobin levels and higher odds of prevalent anemia compared with normal weight. In the fully adjusted logistic model, underweight status remained significantly associated with prevalent anemia (aOR = 3.738, 95% CI: 1.648-8.483, P = 0.002), whereas overweight and obesity were not independently associated with anemia. Conclusion:In postmenopausal women hospitalized with OVCFs, underweight status was associated with lower hemoglobin levels and higher odds of prevalent anemia, while overweight and obesity were not independently associated with anemia. Underweight status may serve as a simple clinical flag prompting hemoglobin and nutritional assessment in this clinically vulnerable fracture population.
Objective:To develop a predictive model for disability risk in older adults using machine learning algorithms. Methods:A convenience sample of 13,809 older adults (aged ≥60 years) was recruited from seven medical institutions, three communities, and five nursing homes in Zunyi City, Guizhou Province. Participants were randomly divided into a training set (n = 9667) and a validation set (n = 4142) at a 7:3 ratio. Disability status was used as the outcome variable. Nine machine learning algorithms-logistic regression, decision tree, random forest, XGBoost, LightGBM, support vector machine, artificial neural network, K‑nearest neighbor, and naïve Bayes-were used to construct prediction models. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), accuracy, and other metrics, and the best‑performing model was selected. The SHapley Additive exPlanations (SHAP) method was used for interpretability analysis of the optimal model. Results:Among the 13,809 participants, 5308 (38.44%) were identified as having disability. Among the nine models, LightGBM achieved the highest AUC (0.859), accuracy (0.792), precision (0.771), sensitivity (0.651), specificity (0.880), and F1 score (0.706). Conclusion:Among the developed prediction models, the LightGBM‑based model demonstrated superior overall predictive performance in internal validation, providing a reference for disability management in older adults.
Objective:This retrospective cohort study compared the efficacy and tolerability of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) between octogenarians (aged ≥80 years) and non-octogenarians with advanced EGFR-mutated lung adenocarcinoma. Methods:We retrospectively analyzed 151 patients with advanced lung adenocarcinoma harboring common EGFR exon 19 deletions or exon 21 L858R mutations who received first-line EGFR-TKI therapy. Patient characteristics, treatment outcomes, and adverse events were evaluated. Results:Progression-free survival (PFS) did not differ significantly between octogenarians and non-octogenarians. Overall survival (OS) was shorter in octogenarians, which may be partly explained by lower rates of subsequent therapy and age-related clinical factors. No significant differences in treatment-related toxicities were observed between the two groups. Conclusion:This study provides clinically relevant real-world evidence supporting the feasibility of first-line EGFR-TKI therapy in octogenarians with EGFR-mutated lung adenocarcinoma. Chronological age alone should not preclude carefully selected very elderly patients from receiving EGFR-TKI treatment.
Background:Population aging has increased the importance of identifying behavioral and psychological factors associated with mental health in later life. Mindfulness exercise (ME), defined as mindful attention and awareness during physical activity, may be related to mental health; however, its underlying psychological mechanisms remain unclear. Methods:A cross-sectional survey was conducted among 450 older adults in Guangdong Province, China. Data were analyzed using partial least squares structural equation modeling (PLS-SEM) with 5000 bootstrap resamples. Validated self-report scales were used to measure mindfulness exercise, coping self-efficacy (CSE), emotion regulation (ER), and mental health (MH). Results:ME was positively associated with CSE, ER, and MH. Coping self-efficacy was positively associated with emotion regulation and mental health, and emotion regulation was positively associated with MH. Mediation analysis indicated that CSE and ER jointly demonstrated a significant sequential mediating association between ME exercise and MH. Conclusion:ME is associated with mental health among older adults, potentially through coping self-efficacy and emotion regulation. However, given the cross-sectional design, these findings should be interpreted as a theory-informed associative model rather than evidence of causality. Longitudinal and experimental studies are needed to further validate these relationships.
Mengqi Shao,1,2,* Qingqing Su,3,* Mingxuan Liu,3,* Chen Qiu,2,4 Mi Song,3 Jianan Li,2,5 Nan Tang,2 Youting Wang,2 Mingxing Lei,3 Jie Song,3,6 Yuan Gao31Department of Cardiovasology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China; 2Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China; 3Department of Nursing, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China; 4Department of Orthopedics, The Forth Medical Center, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China; 5Department of Oncology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China; 6Department of Critical Care Medicine, General Hospital of Western Theater Command of the Chinese People’s Liberation Army, Chengdu, 610036, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jie Song, Email 285619923@qq.com Yuan Gao, Email gaoyuanzd@163.comObjective: This study aimed to investigate osteoporosis knowledge (OK) profiles among older women with fragility fractures using latent profile analysis, identify subgroup characteristics, and explore associated factors.Methods: A cross-sectional survey was conducted among 9212 older women with fragility fractures covering 31 provinces in China from September to November 2023. The survey utilized a self-designed general information questionnaire and the Chinese version of the Osteoporosis Knowledge Assessment Tool. Univariate analysis and logistic regression were employed to analyze associated factors. Latent Profile Analysis was applied to classify the older women with fragility fractures based on their OK levels, and multinomial logistic regression was used to identify factors influencing their OK levels.Results: Older women with fragility fractures were classified into five distinct latent profiles according to their OK levels: Low OK group (9.9%), Medium-Low OK group (11.1%), High OK group (50.9%), Medium OK group (18.8%), and High awareness and low management group (9.3%). Key factors influencing the classification of OK levels included marital status, BMI, education level, filial care, postoperative self-care ability, receipt of anti-osteoporosis therapy, use of calcium or vitamin D supplements, perceived necessity of fall prevention, receipt of health education, content of health education, and methods of health education delivery.Conclusion: The OK levels of older women with fragility fractures can be stratified into five distinct profiles. Understanding the heterogeneity of OK levels and its associated factors among this population offers valuable insights for healthcare professionals to formulate targeted interventions. This study makes a significant contribution to the advancement of secondary prevention strategies for osteoporosis.Keywords: fragility fractures, aged, women, latent profile analysis, cross-sectional study, osteoporosis knowledge assessment tool
Hang Zhang, Huajun Wang, Qianli Ma, Fengwu Shi, Jinghui AnDepartment of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of ChinaCorrespondence: Jinghui An, Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei, 050004, People’s Republic of China, Tel +86-0311-66002994, Email anjinghui2009@126.comPurpose: Despite the success of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS), a subset of older adults experience poor functional recovery. We aimed to develop and validate a pragmatic clinical risk score to predict poor 6-month functional outcomes in this population.Methods: We conducted a retrospective cohort study of 204 elderly patients (≥ 65 years, 106 males and 98 females) with severe AS who underwent TAVR at our center between March 2021 and March 2024. The primary endpoint was poor functional outcome at 6 months, defined as a composite of failure to improve left ventricular ejection fraction (LVEF) by > 10% and failure to increase 6-minute walk test (6MWT) distance by > 50 meters. Patients were randomly split into a training cohort (n=143) and a validation cohort (n=61). LASSO regression was used in the training cohort to identify predictors and construct the TAVR-PRO (Transcatheter Aortic Valve Replacement - Poor Recovery Outcome) risk score. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and calibration plots. A secondary endpoint of 1-year all-cause mortality was analyzed using Kaplan-Meier curves.Results: Five independent predictors were incorporated into the TAVR-PRO score: advanced age (≥ 80 years), Clinical Frailty Scale (CFS) > 4, NT-proBNP > 3000 pg/mL, coronary artery disease, and chronic kidney disease (eGFR < 45 mL/min/1.73m2). The score demonstrated good discrimination in both the training (AUC = 0.88) and validation cohorts (AUC = 0.86), with excellent calibration. Higher scores were significantly associated with poor functional outcome and increased 1-year all-cause mortality (P < 0.001).Conclusion: The TAVR-PRO score, based on five readily available variables, is a simple and effective tool for predicting poor functional outcomes and mortality after TAVR in older adults. This score can aid in shared decision-making, patient counseling, and identifying high-risk individuals for targeted interventions.Keywords: transcatheter aortic valve replacement, aortic stenosis, risk score, functional outcome, frailty, geriatric cardiology
Purpose:Hemodynamic instability during tracheal intubation in elderly patients poses significant perioperative risks. This study aimed to determine the effective doses (ED50/ED95) of remifentanil combined with remimazolam to suppress intubation-induced stress responses while minimizing hypotension in patients aged ≥60. Patients and Methods:In this prospective, double-blind trial, 29 elderly patients received remimazolam (0.3 mg/kg) followed by rocuronium and remifentanil (initial dose: 1 µg/kg, adjusted via Dixon's up-down method). Hemodynamic parameters (blood pressure, heart rate, systemic vascular resistance, cardiac output) and bispectral index (BIS) were recorded. Probit regression analyzed dose-response relationships. A positive hemodynamic response was defined as an increase in systolic blood pressure or heart rate exceeding 20% of the baseline value within 5 minutes after endotracheal intubation. Dixon's up-and-down method and probit regression analysis to determine the ED50 and ED95 of remifentanil combined with remimazolam to suppress intubation-induced stress responses in elderly patients. Results:The ED50 and ED95 of remifentanil were 0.85 µg/kg (95% CI: 0.80-0.90) and 0.97 µg/kg (95% CI: 0.91-1.21), respectively. Positive responders showed elevated blood pressure at 30s-1 min post-intubation (P<0.05), while cardiac output and systemic vascular resistance remained comparable between groups. Hypotension incidence was low (14.3-20%), with transient BIS elevations (60-70) in 51.7% of patients but no intraoperative awareness. Conclusion:In this exploratory dose-finding study, the estimated ED50 and ED95 of remifentanil for suppressing intubation-related hemodynamic responses during remimazolam-based induction were 0.85 and 0.97 μg/kg, respectively.
Background:Post-anesthesia care unit (PACU) delirium in older surgical patients is poorly characterized in Chinese multicenter settings, and whether nursing-sensitive PACU variables add explanatory value beyond conventional clinical risk factors has not been formally tested. Methods:In this prospective cohort study across five Chinese tertiary hospitals, 2200 patients aged 65 years or older undergoing elective major noncardiac surgery (after excluding 60 with persistent deep sedation) were assessed for PACU delirium using a Richmond Agitation-Sedation Scale (RASS)-gated, repeated Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) protocol at three timepoints (10-20 and 40-60 minutes after admission, and before discharge). Two prespecified nested logistic models were compared in an explanatory framework: Model A (conventional clinical predictors) and Model B (Model A plus eight nursing-sensitive PACU variables). Complete-case analysis included 2,048 patients; models were compared using the likelihood ratio (LR) test, C-statistic, and integrated discrimination improvement (IDI). Results:PACU delirium occurred in 422 of 2,200 patients (19.2%; 95% CI: 17.6%-20.9%) and was predominantly hypoactive (64.2%). In descending order of effect size, independent conventional correlates were known cognitive impairment, chronic kidney disease, ASA ≥ III, stroke/TIA, older age, anxiety, lower MoCA, and lower albumin. Adding the nursing-sensitive block modestly improved overall fit (LR test p = 0.037), but the discrimination gain was small (C-statistic 0.675 to 0.686; ∆AUC = +0.011) and the IDI was non-significant (IDI = +0.008, p = 0.384); urinary catheterization was the only independent nursing-sensitive correlate (OR 1.49; 95% CI: 1.18-1.89; p = 0.0009). PACU delirium was associated with all secondary outcomes, including ward delirium (OR 3.26), falls (OR 4.63), non-home discharge (OR 4.75), and prolonged hospitalization (geometric mean ratio 1.46), all p < 0.001. Conclusion:PACU delirium affected approximately one in five older patients and was predominantly hypoactive. The nursing-sensitive block added statistically detectable but clinically limited discriminative value, with the signal concentrated in urinary catheterization. Structured, repeated PACU delirium screening-particularly for hypoactive presentations-and targeted catheter minimization are practical nursing priorities; external validation is required before any bedside risk prediction.
Background:Chronotropic incompetence (CI) is an exercise-derived marker of impaired heart rate response with prognostic relevance in myocardial perfusion imaging, but its interpretation may vary by definition, particularly in older patients. We retrospectively compared three CI definitions in patients with suspected coronary artery disease undergoing symptom-limited exercise stress single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). Methods:In this dual-center cohort, 1,135 patients undergoing exercise stress SPECT-MPI were evaluated. CI was defined as failure to achieve 85% of age-predicted maximal heart rate (CI-APMHR), heart rate reserve <80% (CI-HRR), or blunted heart rate reserve below a sex-specific lower limit of normal (CI-Blunted). The primary endpoint was major adverse cardiovascular events (MACE). Prevalence, agreement, multivariable Cox associations, incremental value beyond total perfusion deficit (TPD) and left ventricular ejection fraction (LVEF), age-stratified analyses, and age-by-CI interactions were assessed. Results:During a median follow-up of 63 months (IQR, 54-70), 144 patients (12.7%) experienced MACE. CI prevalence differed substantially across definitions: CI-HRR 83.9%, CI-Blunted 72.2%, and CI-APMHR 55.1% (all P < 0.001). Pairwise agreement was fair to moderate (κ range: 0.370-0.574). All three definitions were independently associated with MACE: CI-APMHR (HR 1.83; 95% CI: 1.25-2.69), CI-HRR (HR 2.92; 95% CI: 1.35-6.33), and CI-Blunted (HR 1.99; 95% CI: 1.21-3.28). Overall, all definitions added incremental prognostic value beyond TPD and LVEF. In patients aged ≥60 years, CI-APMHR showed the most consistent incremental performance. Age-by-CI interactions were not significant. Conclusion:CI classification in exercise SPECT-MPI was definition-dependent. Although all three definitions were associated with MACE, their incremental prognostic performance beyond TPD and LVEF differed. In descriptive age-stratified analyses, CI-APMHR showed the most consistent incremental prognostic signal in patients aged ≥60 years. However, age-by-CI interactions were not statistically significant, supporting cautious, age-informed interpretation rather than definitive age-related effect modification.
Background:Frailty and systemic inflammation/immune-protein reserve may drive adverse outcomes after endometrial cancer (EC) surgery in older patients, but their incremental predictive value is unclear. Methods:We analyzed a retrospective cohort of women ≥65 years undergoing primary EC surgery between January 2016 and December 2024. Frailty was assessed using mFI‑5. Inflammation-nutrition status (INS) was derived from routine preoperative laboratory tests as exploratory composite. The primary endpoint was 30‑day severe complications (Clavien-Dindo III-V), and the secondary endpoint was 90‑day unplanned readmission to the index hospital. One‑year non-endometrial cancer (non‑EC) death was exploratory with EC death as a competing event. Logistic regression and Fine-Gray models were fitted. Incremental prediction versus a prespecified baseline perioperative clinical model was evaluated with bootstrap optimism‑corrected discrimination, calibration, and decision‑curve analysis. Results:Severe complications occurred in 62 (7.1%) and readmission in 71 (8.1%). One‑year non‑EC and EC deaths were 28 (3.2%) and 19 (2.2%), respectively. mFI‑5 and INS predicted severe complications (OR per 1‑point mFI‑5 1.43 [95% CI 1.22-1.67]; OR per 1‑SD INS 1.34 [1.15-1.55]) and readmission (OR 1.28 [1.10-1.50]; OR 1.22 [1.05-1.41]). For non‑EC death, mFI‑5 (SHR 1.52 [1.23-1.88]) and INS (SHR 1.37 [1.11-1.69]) were significant. Adding mFI‑5+INS improved discrimination (AUC 0.69 to 0.77 for complications; 0.63 to 0.70 for readmission) and the time-dependent C-index for the exploratory competing-risk endpoint (0.66 to 0.73), with acceptable calibration. Decision-curve findings were descriptive rather than definitive. Conclusion:Combining frailty with an objective inflammation-nutrition risk composite modestly improved internal model performance for 30-day severe complications and 90-day readmission in older EC patients, and 1-year non-EC death analysis remains exploratory. These findings should be interpreted as perioperative rather than purely preoperative prediction, and decision thresholds require external validation before protocolized use.
Purpose:Social frailty and oral health literacy (OHL) may be influenced by the residential environment; however, evidence regarding regional differences among older adults remains limited. This study aimed to examine differences in social frailty and OHL between older adult study populations recruited from urban and rural areas. Patients and Methods:This cross-sectional study included 176 community-dwelling older adults (88 participants in the urban study population and 88 participants in the rural study population) enrolled between November 2024 and November 2025. Social frailty was assessed using a five-item assessment, and OHL was evaluated using a 16-item questionnaire. Oral health status was assessed using the Japanese version of the Oral Health Assessment Tool (OHAT-J), and health-related quality of life (QOL) was measured using the Short Form-8 (SF-8). Ordinal logistic regression and multinomial logistic regression analyses were performed to examine the associations of study population (rural vs urban) with social frailty and OHL, respectively, adjusting for demographic and health-related factors. Results:Compared with the urban study population, the rural study population showed a higher prevalence of social frailty (p = 0.004) and low OHL (p < 0.001). In contrast, mental health-related QOL and oral health status were more favorable in the rural study population (p < 0.001). Multivariable analyses showed that participants in the rural study population had higher levels of social frailty and lower OHL than those in the urban study population. Conclusion:Participants in the rural study population demonstrated favorable mental health-related QOL and oral health status; however, higher levels of social frailty and lower OHL were also observed. Given the cross-sectional design and differences in participant recruitment settings between the two study populations, these findings should be interpreted as exploratory and hypothesis-generating rather than as definitive evidence of causal relationships. Nevertheless, these findings may inform the development of region-specific, integrated approaches that combine support for social participation with improved access to health-related information.
Misaki Ichinomiya,1 Yasuhiko Shirayama,2 Shinji Fujiwara,3 Mio Kitamura,4 Shino Suma,5 Kosuke Kataoka1,51Department of Oral Health Science and Social Welfare, Graduate School of Biomedical Sciences, Tokushima University, Tokushima City, Tokushima, Japan; 2Tokushima University, Tokushima City, Tokushima, Japan; 3Mima Municipal Koyadaira Clinic, Mima City, Tokushima, Japan; 4Department of Community Medical and Welfare, Graduate School of Biomedical Sciences, Tokushima University, Tokushima City, Tokushima, Japan; 5Department of Preventive Dentistry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima City, Tokushima, JapanCorrespondence: Kosuke Kataoka, Department of Oral Health Science and Social Welfare, Graduate School of Biomedical Sciences, Tokushima University, Tokushima City, Tokushima, Japan, Email kataoka-k@tokushima-u.ac.jpPurpose: Social frailty and oral health literacy (OHL) may be influenced by the residential environment; however, evidence regarding regional differences among older adults remains limited. This study aimed to examine differences in social frailty and OHL between older adult study populations recruited from urban and rural areas.Patients and Methods: This cross-sectional study included 176 community-dwelling older adults (88 participants in the urban study population and 88 participants in the rural study population) enrolled between November 2024 and November 2025. Social frailty was assessed using a five-item assessment, and OHL was evaluated using a 16-item questionnaire. Oral health status was assessed using the Japanese version of the Oral Health Assessment Tool (OHAT-J), and health-related quality of life (QOL) was measured using the Short Form-8 (SF-8). Ordinal logistic regression and multinomial logistic regression analyses were performed to examine the associations of study population (rural vs urban) with social frailty and OHL, respectively, adjusting for demographic and health-related factors.Results: Compared with the urban study population, the rural study population showed a higher prevalence of social frailty (p = 0.004) and low OHL (p < 0.001). In contrast, mental health–related QOL and oral health status were more favorable in the rural study population (p < 0.001). Multivariable analyses showed that participants in the rural study population had higher levels of social frailty and lower OHL than those in the urban study population.Conclusion: Participants in the rural study population demonstrated favorable mental health–related QOL and oral health status; however, higher levels of social frailty and lower OHL were also observed. Given the cross-sectional design and differences in participant recruitment settings between the two study populations, these findings should be interpreted as exploratory and hypothesis-generating rather than as definitive evidence of causal relationships. Nevertheless, these findings may inform the development of region-specific, integrated approaches that combine support for social participation with improved access to health-related information.Keywords: social frailty, oral health literacy, regional differences, older adults
Purpose:This study aims to identify the direct and indirect pathways associated with Oral health literacy (OHL) among Chinese older adults and to inform targeted oral health promotion strategies for older adults. Patients and Methods:This cross-sectional study included 423 community-dwelling adults aged 65-74 years from a nationally representative key population surveillance project in China. Standardized clinical dental examinations and validated questionnaires were conducted. OHL was assessed using oral health belief (OHB) scores (0-4) and oral disease awareness (ODA) scores (0-8). Variables were categorized according to Andersen's behavioral model into predisposing, enabling/behavioral, and need factors. Poisson regression identified associated factors, followed by path analysis, mediation decomposition, and exploratory multi-group analyses. Results:Median OHB and ODA scores were 3 (IQR: 3-4) and 5 (IQR: 3-6), respectively. In the path analysis, gender and education level were indirectly associated with OHL through mediating factors; root decayed and filled teeth (Root DFT) were directly and positively associated with both OHB and ODA; dental prosthesis use was directly associated with higher OHB, whereas dental visit was directly associated with higher ODA. Sweetened beverage consumption ≥ 1/day showed a negative direct association with OHB, although this estimate was based on only 10 participants and should be interpreted with caution. Three total indirect effects and five specific indirect pathways reached (marginal) significance. In exploratory subgroup analyses, the patterns of path coefficients varied descriptively across education and residence subgroups, but no interaction term was statistically significant. Conclusion:Among older Chinese adults, OHL was associated with a combination of predisposing, need, and enabling/behavioral factors. Dental treatment encounters may provide opportunities for reinforcing oral health education. Subgroup-tailored oral health education strategies may be beneficial.
Purpose:Randomized trials have established that capnography reduces hypoxemia during sedated gastrointestinal endoscopy, but how capnography alters provider behavior in routine practice remains unclear. We aimed to quantify the association between capnography display visibility and hypoxemia episode duration in older adults undergoing sedated gastrointestinal endoscopy. Patients and Methods:We conducted a multicenter clinician-blinded device evaluation across three tertiary hospitals in China (November 2022 - February 2024). Of 1229 patients aged ≥65 years screened; 1,189 were enrolled. Capnography hardware was attached to all patients, with waveform display and alarms accessible in the visible group (n=620) and obscured/muted in the concealed group (n=569). The primary outcome was cumulative hypoxemia duration (subclinical [90-95% SpO2], moderate [85-90%], severe [≤85%]), analyzed using inverse probability of treatment weighting-adjusted zero-inflated negative binomial regression. Results:Hypoxemia incidence did not differ between groups at any threshold (subclinical: 28.7% versus 30.1%; P=0.569). Capnography visibility was associated with 30% shorter subclinical hypoxemia duration (incidence rate ratio 0.70, 95% CI 0.54-0.91; P=0.007) and a model-derived estimated 30-40 second earlier response interval. Moderate hypoxemia showed a directionally consistent trend (IRR 0.69, 95% CI 0.46-1.04; P=0.074); severe hypoxemia duration did not differ (P=0.514). Airway interventions were 86% more frequent in the visible group (RR 1.86, 95% CI 1.57-2.19; P<0.001), predominantly jaw-thrust maneuvers. Hypotension occurred in 1.8% of the visible group versus 0% of the concealed group (P=0.004). Sensitivity analyses demonstrated result stability (E-value ≥2.5; consistent across center exclusions). Conclusion:Visible capnography was associated with shorter subclinical hypoxemia duration and more frequent early airway interventions, consistent with an information-mediated provider response mechanism. These findings characterize how capnography visibility is associated with early detection and provider behavioral change in routine practice, complementing incidence-reduction evidence from randomized trials. All findings are reported as associations; no causal claims are made.
Purpose:Identifying older adults at risk of frailty is crucial for early intervention. Although numerous prediction models have emerged, no scoping review has systematically mapped their methodological trends and barriers to clinical implementation. This scoping review aimed to examine methodological characteristics, model performance, and translational gaps in frailty onset prediction models for older adults. Methods:A systematic search of six Chinese and English databases was conducted from inception to February 2026following Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Results:Thirty studies, reporting 31 frailty prediction models published between 2018 and 2026, were included. Six overarching trends emerged: Most studies originated from China (73.33%), and community-dwelling older adults were the predominant study population (73.33%). After 2024, longitudinal designs using larger public databases became more common; Machine learning was increasingly adopted (38.7%) but showed no clear advantage over logistic regression (median AUC 0.813 vs 0.860); Conventional predictors, including age, multimorbidity, and depression, remained dominant; Calibration was under-reported, particularly in machine learning models (50%); Clinical translation was limited, with external validation and Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis plus Artificial Intelligence (TRIPOD+AI) adherence each reported in only 22.6% of models, static presentation formats predominating (83.9%), and no studies evaluating health economic outcomes or prospective clinical impact. Conclusion:Frailty prediction models are constrained by insufficient calibration reporting, limited external validation, and substantial translation barriers. Future research should prioritize rigorous external validation, TRIPOD+AI adherence, and clinically integrated digital tools supported by implementation science.
Purpose:To explore the relationship between physical function and depressive and anxiety symptoms among older adults, and to determine whether poorer physical function is associated with higher levels of depressive symptoms. Patients and methods:This retrospective analysis included data from the comprehensive geriatric assessments of 491 patients aged ≥65 years who visited the Geriatric Outpatient Clinic or were hospitalized at the Geriatric Department of Beijing Tongren Hospital between November 2021 and December 2023. After excluding cases with incomplete data, 443 participants were included in the final analysis. Physical function was assessed using grip strength, the Timed Up and Go Test (TUGT), 4-meter walk speed, the five-time sit-to-stand test, the three-posture test, and the Short Physical Performance Battery (SPPB). Depressive and anxiety symptoms were evaluated using the Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS). Correlations between physical function and depressive and anxiety symptoms were analyzed, and factors associated with depressive symptoms were examined. Results:The prevalence of depressive and anxiety states was 15.6% and 12.0%, respectively. Participants with depressive symptoms had significantly lower SPPB scores compared with those without (5.83 ± 2.70 vs 8.68 ± 2.14, P < 0.05). SPPB scores were moderately negatively correlated with depressive symptoms (r = -0.404, P < 0.05). Logistic regression showed that higher SPPB scores were associated with lower odds of depressive symptoms (OR = 0.557, 95% CI: 0.411-0.754), whereas longer TUGT time (OR = 1.123, 95% CI: 1.018-1.238) and higher anxiety scores (OR = 1.273, 95% CI: 1.185-1.368) were associated with higher odds. ROC analysis showed that SPPB score was associated with depressive symptoms (AUC = 0.859), with sensitivity of 0.86 and specificity of 0.67 at the optimal cutoff of 8.5. TUGT and anxiety scores also showed associations with depressive symptoms (AUC = 0.844 and 0.891, respectively; both P < 0.05). Conclusion:Declining physical function was associated with depressive symptoms among older adults. Within comprehensive geriatric assessments (CGA), routine SPPB evaluation alongside depressive symptom monitoring may help identify vulnerable older individuals and maintain intrinsic capacity.
Background:Older adults with atrial fibrillation (AF)-associated acute ischemic stroke are prone to disability, depressive symptoms, and falls; the prognostic value of vitamin D status is uncertain. Methods:We conducted a single-center prospective cohort study of patients aged ≥65 years with ECG-confirmed AF and imaging-confirmed acute ischemic stroke at a tertiary hospital in China (January 2022-August 2024). Serum 25-hydroxyvitamin D [25(OH)D] within 48 hours was modeled per 10 ng/mL decrement and as <20 vs ≥20 ng/mL. Outcomes were 3-month modified Rankin Scale (mRS) shift, Barthel Index (BI), and PHQ-9 ≥10, plus 12-month time to first fall (death as a competing event) and total falls rate. Models adjusted for prespecified baseline confounders. Results:Among 802 participants, median age was 76.2 years (IQR, 71.6-80.6); 60.7% had 25(OH)D <20 ng/mL. Three-month mRS/BI, 3-month PHQ-9, and falls follow-up data were available for 776 (96.8%), 762 (95.0%), and 742 (92.5%) participants, respectively. Each 10 ng/mL lower 25(OH)D was associated with worse 3-month mRS shift (common OR 1.17, 95% CI 1.05-1.31) and lower BI (β -3.9, 95% CI -6.2 to -1.6). Depressive symptoms occurred in 16.8% and were more common with 25(OH)D <20 ng/mL (OR 1.54, 95% CI 1.07-2.22). Among 742 with falls follow-up, low 25(OH)D predicted first fall (HR 1.29, 95% CI 1.07-1.55) and a higher recurrent falls rate (IRR 1.33, 95% CI 1.10-1.61). Conclusion:Lower baseline 25(OH)D was consistently associated with poorer functional recovery, greater depressive symptom burden, and higher fall risk and recurrence, supporting 25(OH)D as a pragmatic prognostic marker; multicenter validation and targeted trials are warranted.
